What Was Done?
Identification of Problem
Communication is often cited as a leading cause for medical errors and preventable harm. Staff communication is a specific aim of this finding that has warranted special attention in recent years. Additionally, a 2021 report published by the Joint Commission lists retained foreign objects as the third most common sentinel event reported nationally.
Specific Aims to Solve It
Coupling these two findings led to a planned simulation where organized and high stakes communication in the operating room can be practiced through simulation. At Baylor Scott and White Temple, administrative and clinical education teams planned an interprofessional surgical debrief educational activity for multiple service lines including a surgeon, anesthesiologist, OR nurses and Surgical Technologists.
How Simulation Was Part of the Solution
To achieve the stated aim, an interprofessional operating room simulation was conducted. A working OR was used to improve realism and participation. The design was a communication-based role play involving key roles: the surgeon, anesthesia provider, certified surgical technologist, and the RN circulator. The event began with a prebrief that introduced the purpose and structure of the simulation to the group, followed by the simulation itself. The learners were asked to participate and discuss two case scenarios, in which they watched several non-OR staff portray the roles described. The learners would observe the demonstrated interaction and provide feedback and discussion during the debrief of each scenario. In the initial scenario, there were multiple communication errors committed by the team in various roles. During the debrief, participants engaged in a group discussion to identify what went wrong, why it was wrong and what could be done to improve it. The second scenario demonstrated proper communication skills by all team members demonstrated during the surgical debrief. Following this, another group discussion was held to highlight what was done correctly. A staff surgeon and anesthesia provider were present to provide additional insight during both debriefs. The simulation activity was conducted twice, once for the morning shift and once for the afternoon shift and both sessions were recorded. In total, 35 staff members (22%) participated in the live events. Additionally, 71 Registered Nurses and 41 Certified Surgical Technologists (72% of staff) viewed the recorded sessions through an Elsevier module created specifically for this purpose.
What Was the Outcome?
The intended outcome was to provide a nonjudgmental and psychologically safe learning environment in which appropriate surgical debrief communication skills for an interprofessional team. The operating room staff consisted of 98 Registered Nurses and 57 Certified Surgical Technologists who were provided the opportunity to learn improved communication and team reflexivity when performing the surgical debrief. The qualitative process improvement and educational opportunity has proved scalable with possible rollouts to other hospitals within the system or shareability with Elsevier module.
A survey was distributed to participants in which we obtained only a 16% capture rate. Drawing conclusions based on this limited data was not possible, however, we did have comments that suggested a very positive experience for learners and a desire for even more realism and engagement. In the future, the module created of the event can be mandatory viewing for new hires or annual assigned training. Additionally, next steps could be a repeat of this activity with surgical residents to determine their engagement in the debrief process.
How Was Hospital Leadership Engaged and/or Notified?
This activity had support from multiple leadership areas. Anesthesiology and surgical physician leadership partnered with Perioperative Director and OR Nursing Professional Development and the Simulation team to create, plan and implement this event. Due to the success of the program, the simulation was discussed and scaled to incorporate into the hospital system level module and experience.
